May 2010

Stephen N. Bauer, MD

Numbers that point to our next steps

The Little Leaguers were practicing at the ballpark when I drove past last night; it must be spring. Opening Day has come and gone, but it never feels like baseball season to me until I see the kids out there. We pay more attention when the action is closer to home.

When I was growing up in California, Sandy Koufax was playing for the Los Angeles Dodgers and resetting all the benchmarks for major league pitching. I was a loyal Giants fan, but you had to respect him even if he was a Dodger. He didn’t talk much, but what he said you would remember and repeat. Like the time he said he liked baseball because players were judged on their numbers. It was a clean game, he said; you knew by the numbers when you had done a good job.

That’s a fair way to explain why the College decided to commission a professional poll to assess the status of our campaign to transform the specialty. Four demographic groups were surveyed over a three-week period earlier this year—1,200 CAP fellows, 500 nonpathologist physicians, 240 people who work and network in Washington, DC, and 500 everyday Americans with an active interest in health policy. The results are still preliminary but helpful all the same. I like having data, especially with an elusive target; it helps to know the score.

The good news, so far as I’m concerned, is that our membership is strongly behind the transformation campaign. Fully 70 percent of CAP members surveyed agree that change is necessary for the field of pathology. “I look forward to doing my part,” these members said. “It is important that the specialty of pathology be substantively transformed in order to remain relevant and competitive in the years ahead.”

Two out of three CAP members agree it is important to make substantive changes in the way they work. Four out of five “are ready for and open to change,” and 54 percent said, “I am willing to help CAP do what it takes to succeed in its transformation efforts.”

Our members endorse the need to change. They are eager to contribute. While 69 percent of CAP members believe our level of intensity on transformation is appropriate, 17 percent said we need even more.

There is some clarity, too, on next steps. Eighty-two percent of CAP members—and 61 percent of other specialists—cited expertise in molecular diagnostics and genomics as critical for pathologists to remain competitive and relevant. Next most desirable in the minds of all physicians was establishing a more proactive role for pathologists in selecting the tests to be used.

Collaboration is on many minds, it seems, which is good. Two out of three nonpathologist physicians would like to collaborate more often with pathologists. Primary care physicians were particularly strong on this point—76 percent felt this way, as did 72 percent of oncologists, 62 percent of gastroenterologists, and 59 percent of OB/GYNs.

For those pathologists who seek a greater role in direct patient consultation and a more visible role on the patient care team, the window of opportunity is wide open: Two-thirds of patients and more than one-third of nonpathologist physicians surveyed would like to see more pathologist-patient consultation. Primary care physicians were again in the lead on that question: 47 percent favor more direct pathologist-patient consultation (along with 34 percent of the oncologists and 34 percent of the OB/GYNs). Our members are prepared to seize that opportunity: Nearly half agreed that greater accessibility to patients was important to our relevance and competitive position.

Consider this, for a moment, in the context of the medical home model, which is one way that has been suggested to address costly fragmentation of care. In this model, primary care physicians will take on more responsibility for coordinating care while grappling with increasingly complex tools and tests. A collaborator who can evaluate an anemia or coagulopathy and consult on treatment alternatives could be a godsend to the overwhelmed primary care practitioner. Given that both patients and primary care physicians are open to more contact with pathologists, this may be a natural niche for us.

The early numbers about how others see us are encouraging. For example, when both patients and policy wonks were presented with a list of 14 terms, ranging from “autopsy” to “testimony,” and asked which they associate most closely with pathology, the top four in both groups (biopsy, diagnosis, laboratory, and testing) had precious little to do with autopsies in detective dramas. Although there were subtle differences in the rankings, each of those terms received at least 55 percent of the votes from both nonphysician cohorts, while cues like “mortuary” and “crime” rated in the teens. It just might be that our patients and policymakers have come to understand that forensic pathologists, while serving a critical role in society, are only one of many subspecialists within our discipline.

A good number of the CAP fellows surveyed said they would like to have a firmer grasp of what transformational pathology looks like, and of what they can do to get there. I think we can say that the quickest route to transformation will involve education in cutting-edge skills (especially molecular diagnostics/genomics), and new collaborative roles, particularly with colleagues who may not realize we are available to consult with them. The College is developing new educational offerings in molecular pathology; online learning options are posted on the Web site. Also, I recommend early registration for CAP ’10 in Chicago, Sept. 26–29. Many seminars and workshops are likely to fill up fast. Be sure to register for the Sept. 28 plenary session on the transformation, a progress report and look to the future that will identify concrete steps each of us can take to make transformational pathology the new norm.

We have our work cut out for us—that’s the bottom line. Our membership understands that transformation is a formidable challenge, and it is clearly on board. We know what we need to do to transform, and when we know what to do, it gets done. With this team, you can count on it.